Risk Management and Healthcare Policy (Jun 2020)
Vancomycin Dosage and Its Association with Clinical Outcomes in Pediatric Patients with Gram-Positive Bacterial Infections
Abstract
Sooyoung Shin,1,2 Hyun Joo Jung,3 Sang-Min Jeon,1 Young-Joon Park,1 Jung-Woo Chae,2 Hwi-Yeol Yun2 1College of Pharmacy, Ajou University, Suwon, Gyeonggi-do 16499, Republic of Korea; 2College of Pharmacy, Chungnam National University, Daejeon 34134, Republic of Korea; 3Department of Pediatrics, Ajou University Hospital, Suwon, Gyeonggi-do 16499, Republic of KoreaCorrespondence: Hwi-Yeol Yun; Jung-Woo Chae Tel +82 42 821 5941; +82 42 821 5929Fax +82 42 823 6566Email [email protected]; [email protected]: The aim of this study was to evaluate whether vancomycin trough concentrations at initial steady state are associated with clinical and microbiological outcomes along with vancomycin-related nephrotoxicity in pediatric patients with Gram-positive bacterial (GPB) infections.Methods: A retrospective cohort study of pediatric patients who received vancomycin for ≥ 72 hours during 2008– 2016 was conducted. Study patients were divided into three cohorts in accordance with their first trough levels at steady state: < 5 mg/L (lower-trough), 5– 10 mg/L (low-trough), and > 10 mg/L (high-trough; reference) cohorts.Results: Of the 201 patients eligible for study inclusion, 60 patients in the lower- and low-trough cohorts, respectively, were idect 3ntified via propensity score matching and analyzed against 30 high-trough patients in each comparison pair (neonates were excluded due to small sample size). Lower-trough patients were at a greater risk for prolonged therapy, retreatment, and dose adjustment than high-trough patients. Final steady-state troughs remained substantially lower in both the lower- and low-trough cohorts (p< 0.001 and p=0.005, respectively), despite greater dose up-titration in the lower-trough cohort and percent change in daily dose in both the lower- and low-trough cohorts than in the high-trough cohort (p< 0.001 for all). Clinical cure and death risk, along with the risks of isolation of resistant strains and renal events, were not significantly different between cohorts in both comparison pairs.Conclusion: Vancomycin troughs of < 5 mg/L at initial steady state were associated with significantly compromised clinical outcomes in terms of risk of therapy prolongation, retreatment, and aggressive dose up-titration, compared to > 10 mg/L troughs in pediatric patients with GPB infections.Keywords: pediatrics, vancomycin, drug monitoring, Gram-positive bacterial infection
